Dr. Richard Feldman: Session has health care wins but misses, too

This was billed as the health-focused legislative session, with emphasis on increasing transparency and reducing medical-care costs. In the end, there were health-related legislative advancements—along with missed opportunities.

House Bill 1004 requires providers to give good-faith estimates of costs on procedures and other elements of medical care upon patient request. To help preserve access and continuity of care, it also protects patients from the effects of “non-compete clauses” when their physicians leave employment of a hospital or other network. Among other provisions, former employers are required to provide patients with their last known contact information for the physician.

Last, HB 1004 attempted to address the problem of “surprise billing.” Patients assume that, in an in-network hospital, all providers are in-network. In fact, balance billing from an “out-of-network” provider might occur.

The bill allows the provider to charge only up to the in-network rate unless the patient is notified five days in advance and agrees to the higher amount. The language does not require insurance to pay that in-network amount, thus the patient might still be theoretically stuck with a surprise bill. This is a disappointing result, and other related issues are left unresolved.

The federal government performed the heavy lifting in accomplishing what the General Assembly could not—increasing the legal age for the sale of tobacco and vaping products to age 21. Federal law was reinforced by Senate Bill 1, which focuses on increased regulation of tobacco retailers and penalties for selling to minors. It ends fines to minors found in possession of or attempting to buy these products, which is counterproductive.

HB 1207 allows pharmacists to expand dispensing of auto-injectable epinephrine to properly trained individuals for emergency use in anaphylaxis (for example, think of camp counselors and bee stings). The bill also provides exceptions to e-prescribing of controlled medications when technologically difficult or impossible or when the prescriber determines it is impractical to best assure timely, quality care. Further, the legislation places some modest new safeguards on coverage modifications for prescription medications during a plan year. Good legislation.

SB 255 allows patients to obtain insulin without a prescription, assuring this medication is always available when needed. Indiana was the only state that did not allow it. HB 1080 lowers the age for required insurance coverage for colorectal cancer screening from the current age 50 to age 45. Colon cancer is significantly increasing in younger people. HB 1182 extends the expiration date of the IV drug-user needle exchange program statute another year. These programs are vital to reducing HIV and hepatitis C in our communities. Common-sense measures.

HB 1070 prohibits hand-held cell phone use while driving. Finally!

In response to reports of high hospital costs in Indiana, SB 5 forms an all-payer claims database that provides information on costs of hospital procedures and other services. The challenge is for the information to be usable, meaningful and understandable. Time will tell.

Pharmacy benefit managers, intermediaries for administration of pharmacy benefits, are thought responsible for adding undue costs to prescription medications. SB 241 is the first step in establishing a regulatory structure, licensure and oversight.

Issues left unaddressed for next session: Prohibition of flavored tobacco and vaping products, non-prescription birth control pills, proper identification to the public of health care providers with the title of “doctor,” and medical marijuana. Other issues likely to arise are independent practice for nurse practitioners and increasing the cigarette tax.

Should be interesting.•

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